MI7

How Would an Integrated Medical Center Affect HMO/Insurance Capitation?

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How Would an Integrated Medical Center Affect HMO/Insurance Capitation?

Contrary to some critics, HMO/insurance capitation have no negative effect to the integrated medical centers.

Let me explain.

What Is a Capitated Contract?

A capitated contract is a healthcare plan that allows payment of a flat fee for each patient it covers. Under a capitated contract, an HMO or managed care organization pays a fixed amount of money for its members to the health care provider. Capitated contracts are also referred to as capitation agreements, capitation contracts and managed care capitated contracts. Within a capitated contract, the healthcare provider is paid a set dollar amount per month to see patients regardless of how many treatments or the number of times the physician or clinic sees the patient. The agreement is that the provider will get a flat, prearranged payment in advance per month. Whether or not the patient needs services in a particular month, the provider will still get paid the same fee. The more treatment a patient need, the less money a health provider makes per treatment.

Traditionally, payers have reimbursed healthcare providers for the costs of services delivered or for the volume of services delivered. However, new types of healthcare plans are moving from paying for volume to paying for value – incorporating cost, consumer health outcomes, and consumer experience – with capitation rates based on performance at the “most advanced” end of the scale.

Capitation-style healthcare contracts were created with the intention of creating better incentives for efficiency, cost control, and preventive care in healthcare. Given that most individuals enrolled in a health plan will never use the services in any given month, capitation arrangements should naturally balance out high-frequency users with plan members who use little or no healthcare every month. Also, because the physician, or health system are responsible for the enrolled member’s health regardless of cost, in theory, capitation motivates the healthcare provider to focus on health screenings and other preventative care that can help keep plan members healthy, with less reliance on costly specialists. Because integrated medical centers are operated with the guidance of a DC as the gate keeper, the HMO option becomes a viable opportunity. Indeed, the very fact that DCs encourage maintenance care while ensuring preventative health habits, the medical integration model is a perfect answer and solution to the nation’s largely mismanaged health care problems.    

At COA, we are proud that our integrated centers play a critical role solving the nation’s health care problems. This greatly anticipated concept gives rise to a new generation of healthcare philosophy called:

“The patient philosophy!”

 

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-career-counseling/guidance/understanding-capitation

https://healthpayerintelligence.com/news/how-capitated-payments-prompt-payer-provider-innovation

https://www.verywellhealth.com/capitation-the-definition-of-capitation-2615119

https://biotech.law.lsu.edu/map/CapitationAgreements.html

MI6

What is the Insurance Companies’ Response to the Proliferation of Integrated Medical Centers?

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What is the Insurance Companies’ Response to the Proliferation of Integrated Medical Centers?

Although some articles have been written about the pros and cons of integrated medical centers for both doctors and patients, one will have to really dig deep to find something about insurance companies’ reactions to the surge of integrated medical centers nationally. Nonetheless, in order for one to better understand what insurance companies “think”, one should first understand what insurance companies all are about.

Insurance is a means of protection from financial loss. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss.

An entity which provides insurance is known as an insurer, insurance company, insurance carrier or underwriter. A person or entity who buys insurance is known as an insured or as a policyholder. The insurance transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer’s promise to compensate the insured in the event of a covered loss. The loss may or may not be financial, but it must be reducible to financial terms, and usually involves something in which the insured has an insurable interest established by ownership, possession, or pre-existing relationship.

The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insurer will compensate the insured. The amount of money charged by the insurer to the policyholder for the coverage set forth in the insurance policy is called the premium. If the insured experiences a loss which is potentially covered by the insurance policy, the insured submits a claim to the insurer for processing by a claims adjuster. The insurer may hedge its own risk by taking out reinsurance, whereby another insurance company agrees to carry some of the risk, especially if the primary insurer deems the risk too large for it to carry.

Being the country’s longest practicing consultant for medically integrated practices, it is my opinion, that insurance companies are not really opposed to integrated medical centers if they are established appropriately and services patients ethically. However, historically, insurance companies have been very concerned that DCs create integrated medical centers primarily to circumvent limitations on chiropractic coverages. 

Case in point, many of my clients have successfully managed very profitable integrated medical centers for decades without ever having any legal issues.

So, in conclusion, can medical integrated centers provide great care and generate great profits? The answer is unequivocally YES, if the center is properly established, managed ethically using appropriate medical protocols.

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

https://www.chicagotribune.com/business/ct-healthcare-real-estate-1011-biz-20151009-story.html

https://www.modernhealthcare.com/patient-care/cvs-aggressively-expand-healthcare-services-stores

https://www.ucsf.edu/news/2015/02/122971/ucsf-medical-center-mission-bay-opens-welcomes-131-patients

https://www.multicare.org/news/58-bed-hospital-opens-in-Covington/

MI5

How Does Medical Integration Benefit a Chiropractor?

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How Does Medical Integration Benefit a Chiropractor?

Many doctors considering medical integration often question the real benefits to their patients as well as to themselves. Over the last many years, the many investigations for medically integrated centers have dampen the enthusiasm of many practitioners. Hence, the question remains a valid concern. What are the true benefits of medical integration?  

  1. Since, the DC, more often than not, performs the initial evaluation, the DC has initial control of the treatment protocols prescribed which will ensure that the chiropractic philosophy is maintained.
  2. Any patients needing any other type of treatments, which is outside of the DC’s scope of practice, will be referred to another practitioner within the same clinic and therefore lessening any chance for the patient to seek care from other outside providers.  
  3. The DC overseeing the treatment protocols will continue to play a critical part of any decision making which will affect the patient’s future physical and mental well-being.
  4. In an integrated medical center, all health care professionals work as a team leading to higher patient retention and therefore better treatment outcome assessment.
  5. Many more conditions will be treated given the various specialists. 
  6. The expansion of the clinic’s services will invariably attract many more patients, which will in turn generate higher billing hence more revenue. 
  7. A group practice can join many more insurance networks and therefore be credentialed to have access to a larger pool of new patients.
  8. Integrated medical centers can have easier access to worthwhile networks which were originally possibly closed to DC’s.   
  9. A DC in a medical integrated center will be able to build a stronger relationship with the medical community thereby generating many medical referrals.
  10. A successfully established medical integrated center can merge with other larger medical facilities.

In conclusion, integrate medical centers today have the ability to treat many more patients without compromising their chiropractic philosophy in a most adulterated genuine way.

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

MI3 scaled

The Challenge of Medical Integration

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The Challenge of Medical Integration

Although many doctors speak about the many advantages of medical integration, it would be naïve to think that there are no negative issues associated with such a complex business model. Having spent over 26 years as a consultant, I have had the privilege to help thousands of doctors realize their dream practice. Yet, being the longest practicing consultant for medically integrated centers, I have had ample opportunities to see how this innovative idea has developed and become so popular today. So, what are some of the negative drawbacks with medical integration?

Basically, there are three major areas to be concerned with:

  • Legalities
  • Billing and Coding
  • Medical supervision and communications.
  1. Legalities

Given the very intricate detailed laws associated with medical integration, the best way to create a safe and sound integrated medical center, is to retain the services of a qualified health care attorney with in-depth knowledge and understanding of the Chiropractic and medical scopes of practice. Before opening the doors of a newly created medical center, it is critical that the infrastructure falls well within legal parameters both at the state and federal level. One only need to look at the current active legal investigations to realize that medical integration is a serious business model which must be properly set up and operated with unadulterated honesty and integrity. Unfortunately, throughout my 26 years as America’s longest practicing consultant for integrated medical centers, I have seen many doctors pay a very heavy price for not wanting to follow “the rules”. What is even more ludicrous, is that many doctors as well as unscrupulous consultants believe that they can do whatever they wish or whatever they consider is right and think they can get away with it. This alarming and risky reasoning can only lead to disastrous results. 

  1. Billing and Coding

Another issue which requires close attention is the convoluted billing and coding system. 

Certainly, one must realize that billing and coding for an integrated medical center is quite complex. Not having a great understanding of how to combine billing codes for services rendered, will create confusion and therefore hinder the ability for any clinic to collect what is truly due. These errors will undoubtedly cause a cash flow shortage and therefore limit the clinic to keep its doors open. Hence, having a qualified and well-trained billing team is not a “luxury” option but an absolute obligation. Unfortunately, today, many consultants have very limited knowledge of the billing reimbursement exceptions which vary from state to state. Therefore, many unscrupulous consultants simply avoid these billing variations issues leaving their clients in the dark. Regardless, the clinic owner should make sure that the staff is well trained in the medical integration billing model before taking such a leap of faith and causing unnecessary added stress to an already complex operation. 

  1. Medical supervision and communications.

It is well known that medical integrated centers treat larger volume of patients. To ensure proper case management, doctors in these multidiscipline centers will need to learn how to efficiently communicate and internally refer to one another. Hence, it is critical that proper protocols are established from the beginning. Just as important is the supervisory role of the medical director. Indeed, due to the wider scope of practice, integrated medical centers offer a wide variety of treatments. As is well known, the treatment of many of these newly added conditions will often require direct medical supervision to ensure compliance and to ensure that none of the doctors are practicing outside the scope of their license. This obviously, could also negatively affect any possible malpractice issue. I am pleased to report that most of our clients nationally have indeed been very fortunate and hardly ever had any issue in this area.    

To end on a positive note, one must know that while there are definite explicit requirements to successfully operate an integrated medical center, with professional guidance, experienced advice and genuine intend, one can set up an amazingly beneficial and lucrative center representing the wave of the future. 

The Nation’s #1 Medical Integration Program

COA’s Medical Integration is USA’s most trusted and reputable program. Dr. Dahan, America’s most recognized leading expert authority on Medical Integration has guided thousands of doctors reach their ultimate potentials. Dr. Dahan owned and managed his two clinics for twelve years in Southern California before he became a consultant. His direct and simple approach as well as his ability to take very complex business and life issues and translate them into real life lessons, has been the hallmark of his success. In the fall of 2019, Dr. Dahan was exclusively chosen to host the Doctors Daily Live Radio Show, addressing physicians’ issues while influencing doctors to reach higher potentials. With brilliant marketing strategies, unmatched healthcare consulting experience and clinic integration expertise, Dr. Dahan has so much to offer. A gifted speaker and accomplished writer, Dr. Dahan shares his advice in his unique, informative manner. His Wisdom Podcasts are downloaded by 52,000 global listeners daily. Dr. Dahan also writes blogs for the VJ Posts and has appeared on the Charlie Harary Radio Show. 

 

https://www.medicaleconomics.com/medical-economics-blog/top-10-challenges-facing-physicians-2018

4 Biggest Challenges of Growing a Medical Practice

https://www.beckershospitalreview.com/finance/how-to-solve-5-common-medical-practice-rcm-problems.html

https://www.verywellhealth.com/top-issues-for-medical-office-managers-2317180